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Pituitary ectopia in the newborn — A multisystemic approach
Abstracts
Abstract UENPS.296 Efficacy and safety of intravenous hydrocortisone for the treatment of refractory hypotension in preterm infants less than 30 weeks-preliminary study Magdalena Rutkowska⁎, Marzanna Resko-Zachara, Ewa Adamska, Mariusz Oltarzewski, Katarzyna Szamotulska Mother and Child Institute, Warsaw, Poland Background and aim Cardiovascular stabilization in infants with ELBW is very difficult in first days after birth. Hypotension in preterm infants is the major risk factor for IVH and poor long term development. The primary treatment of the hypotension involves volume replacement and the institution of inotropes. There is a group of extreme premature infants who fail to complete adrenal adaptive process for sometime following birth and may exhibit signs of adrenal insufficiency (e.g. hypotension). These infants do not respond to volume or pressors administration. Intravenous hydrocortisone maybe useful for refractory hypotension treatment. Materials and methods The aim of this study was to determine the efficacy and safety of intravenous hydrocortisone for the treatment of refractory hypotension in preterm infants GA < 30 weeks. A secondary purpose was to measure the baseline serum cortisol concentration in first days after birth and its correlation with cardiovascular stabilization. 35 babies hospitalized between 01/01/07–31/12/07 were included. Baseline serum cortisol concentrations were determined within first 72 h of life using LIA method. We defined a hypotension as a MAP below GA and diuresis less than 1 mL/kg/d. The first line of treatment was 0.9% NaCl (10– 20 mL/kg) as a volume replacement followed by the institution of inotropes (Dopamine and/or Dobutamine 5–10 mcg/kg/min). In neonates who did not respond for that treatment the refractory hypotension was recognized and hydrocortisone (1 mg/kg) was started. Results Plasma cortisol values were spread between 58.5–3766.5 nmol/L (the median 293.8 nmol/L) and no correlation with GA was observed. 24 infants required inotropes administration, of those 10 received hydrocortisone treatment additionally. There were no incidence of SIP and PVL in both groups. The hyperglycaemia incidence was comparable in two groups (50%).The incidence of grades III and IV IVH was higher in infants with hypotension (51%), comparing with normotensive babies (9%). Conclusions 1. 2. 3. 4.
No correlation between GA and cortisol concentration was revealed. No incidence of SIP and PVL was found in babies who received hydrocortisone treatment. The hyperglycaemia incidence was comparable in two groups. The incidence of grades III to IV IVH was significant in all babies with hypotension requiring treatment.
S121
The aim is to report a newborn with idiopathic hypopituitarism who showed an ectopic posterior pituitary and absent pituitary stalk on imaging. Materials and methods Case report of a term newborn (fifth son of healthy parents) presenting since delivery bradycardia and hypotension needing inotropic support associated with persistent hypoglycaemia. Transferred at 17th day to the HDE medical-surgical NICU with IIIB Bell's classified necrotizing enterocolittis (NEC) which resolved with segmental bowel resection and illeostomy. The physical examination showed some morphological abnormalities such as non-descended testis and micropenis. Endocrinological study evidenced low serum levels of pituitary secreted hormones (TSH, ACTH, GH, IGF1, prolactyn, FSH, LH and testosterone). The central nervous system MRI scan showed a pituitary gland ectopia which confirmed the diagnosis. Results Substitution therapy with levothyroxin, hydrocortisone, and growth hormone was started resulting in normalization of heart rate, blood pressure and glycaemia. Conclusions This case is a paradigm of the multisystemic presentation of pituitary ectopia. The difficult diagnosis sometimes leads to secondary severe complications such as NEC. Hormone replacement is needed to achieve clinical control. doi:10.1016/j.earlhumdev.2008.09.313
Abstract UENPS.298 Neonatal hypothyroidism, necrotizing enterocolitis — Do they appear together?
Y. Noel⁎,a, Y. Zakb, S. Yurmana, M. Feldmana Hillel Yaffe Medical Center, Hadera, Israel b Sheba Medical Center, Tel-Hashomer, Israel a
Background and aim Necrotizing Enterocolitis (NEC) of large and small intestines, is an emergency situation in the newborn's digestive systems. Currently the etiology is unknown, and treatment is far from effective. Former research confirmed that thyroid gland hormones are essential for normal nervous system's development in fetus and infant. Hypothyroidism causing electrical and mechanical activity decrease in digestive system may cause decrease of peristalsis; ileus; meteorism of stomach and lessening of blood to intestinal lining. Immediately after birth, thyroxin and thyrotropin levels change significantly. 80% premature infants during their first 3–8 weeks are in state of Transient Hypothyroxinemia (TH). The lower the week of birth, the increase in TSH is smaller as are the levels of T4 and T3.
doi:10.1016/j.earlhumdev.2008.09.312 Aim
Abstract UENPS.297 Pituitary ectopia in the newborn — A multisystemic approach
To examine causal relationship between over incidence of NEC and Hypothyroidism. Materials and methods
Pedro Garcia⁎, Ana Pita, Sérgio Pinto, Guilhermina Fonseca, Micaela Serelha Hospital Dona Estefânia, Lisbon, Portugal Background and aim Posterior pituitary ectopia refers to an absent normal posterior pituitary bright spot within the sella with ectopic bright signal at another site (such as the median eminence) on a weighted magnetic resonance.
Retrospective study on our patient files, hospitalized newborns between 1995–2005, and Patient files from 2 additional hospitals between 2001–2005. We included 71 newborns defined by Bell's Classification as NEC levels 2–3. 28 babies were excluded: 16 NEC level 1; 10 missing thyroid functioning results; 2 died of NEC. The 43 cases included were born between 24–40 weeks with birth weight between 730–3825 g.
Abstract UENPS.296 Efficacy and safety of intravenous hydrocortisone for the treatment of refractory hypotension in preterm infants less than 30 weeks-preliminary study Magdalena Rutkowska⁎, Marzanna Resko-Zachara, Ewa Adamska, Mariusz Oltarzewski, Katarzyna Szamotulska Mother and Child Institute, Warsaw, Poland Background and aim Cardiovascular stabilization in infants with ELBW is very difficult in first days after birth. Hypotension in preterm infants is the major risk factor for IVH and poor long term development. The primary treatment of the hypotension involves volume replacement and the institution of inotropes. There is a group of extreme premature infants who fail to complete adrenal adaptive process for sometime following birth and may exhibit signs of adrenal insufficiency (e.g. hypotension). These infants do not respond to volume or pressors administration. Intravenous hydrocortisone maybe useful for refractory hypotension treatment. Materials and methods The aim of this study was to determine the efficacy and safety of intravenous hydrocortisone for the treatment of refractory hypotension in preterm infants GA < 30 weeks. A secondary purpose was to measure the baseline serum cortisol concentration in first days after birth and its correlation with cardiovascular stabilization. 35 babies hospitalized between 01/01/07–31/12/07 were included. Baseline serum cortisol concentrations were determined within first 72 h of life using LIA method. We defined a hypotension as a MAP below GA and diuresis less than 1 mL/kg/d. The first line of treatment was 0.9% NaCl (10– 20 mL/kg) as a volume replacement followed by the institution of inotropes (Dopamine and/or Dobutamine 5–10 mcg/kg/min). In neonates who did not respond for that treatment the refractory hypotension was recognized and hydrocortisone (1 mg/kg) was started. Results Plasma cortisol values were spread between 58.5–3766.5 nmol/L (the median 293.8 nmol/L) and no correlation with GA was observed. 24 infants required inotropes administration, of those 10 received hydrocortisone treatment additionally. There were no incidence of SIP and PVL in both groups. The hyperglycaemia incidence was comparable in two groups (50%).The incidence of grades III and IV IVH was higher in infants with hypotension (51%), comparing with normotensive babies (9%). Conclusions 1. 2. 3. 4.
No correlation between GA and cortisol concentration was revealed. No incidence of SIP and PVL was found in babies who received hydrocortisone treatment. The hyperglycaemia incidence was comparable in two groups. The incidence of grades III to IV IVH was significant in all babies with hypotension requiring treatment.
S121
The aim is to report a newborn with idiopathic hypopituitarism who showed an ectopic posterior pituitary and absent pituitary stalk on imaging. Materials and methods Case report of a term newborn (fifth son of healthy parents) presenting since delivery bradycardia and hypotension needing inotropic support associated with persistent hypoglycaemia. Transferred at 17th day to the HDE medical-surgical NICU with IIIB Bell's classified necrotizing enterocolittis (NEC) which resolved with segmental bowel resection and illeostomy. The physical examination showed some morphological abnormalities such as non-descended testis and micropenis. Endocrinological study evidenced low serum levels of pituitary secreted hormones (TSH, ACTH, GH, IGF1, prolactyn, FSH, LH and testosterone). The central nervous system MRI scan showed a pituitary gland ectopia which confirmed the diagnosis. Results Substitution therapy with levothyroxin, hydrocortisone, and growth hormone was started resulting in normalization of heart rate, blood pressure and glycaemia. Conclusions This case is a paradigm of the multisystemic presentation of pituitary ectopia. The difficult diagnosis sometimes leads to secondary severe complications such as NEC. Hormone replacement is needed to achieve clinical control. doi:10.1016/j.earlhumdev.2008.09.313
Abstract UENPS.298 Neonatal hypothyroidism, necrotizing enterocolitis — Do they appear together?
Y. Noel⁎,a, Y. Zakb, S. Yurmana, M. Feldmana Hillel Yaffe Medical Center, Hadera, Israel b Sheba Medical Center, Tel-Hashomer, Israel a
Background and aim Necrotizing Enterocolitis (NEC) of large and small intestines, is an emergency situation in the newborn's digestive systems. Currently the etiology is unknown, and treatment is far from effective. Former research confirmed that thyroid gland hormones are essential for normal nervous system's development in fetus and infant. Hypothyroidism causing electrical and mechanical activity decrease in digestive system may cause decrease of peristalsis; ileus; meteorism of stomach and lessening of blood to intestinal lining. Immediately after birth, thyroxin and thyrotropin levels change significantly. 80% premature infants during their first 3–8 weeks are in state of Transient Hypothyroxinemia (TH). The lower the week of birth, the increase in TSH is smaller as are the levels of T4 and T3.
doi:10.1016/j.earlhumdev.2008.09.312 Aim
Abstract UENPS.297 Pituitary ectopia in the newborn — A multisystemic approach
To examine causal relationship between over incidence of NEC and Hypothyroidism. Materials and methods
Pedro Garcia⁎, Ana Pita, Sérgio Pinto, Guilhermina Fonseca, Micaela Serelha Hospital Dona Estefânia, Lisbon, Portugal Background and aim Posterior pituitary ectopia refers to an absent normal posterior pituitary bright spot within the sella with ectopic bright signal at another site (such as the median eminence) on a weighted magnetic resonance.
Retrospective study on our patient files, hospitalized newborns between 1995–2005, and Patient files from 2 additional hospitals between 2001–2005. We included 71 newborns defined by Bell's Classification as NEC levels 2–3. 28 babies were excluded: 16 NEC level 1; 10 missing thyroid functioning results; 2 died of NEC. The 43 cases included were born between 24–40 weeks with birth weight between 730–3825 g.